2023 Manuals and Regulatory Trainings

These Benefit Manuals are offered as guidelines to determine benefit eligibility and are not intended to be construed as or to serve as a standard of medical care, or as a contractual agreement for payment. Standards of medical care are determined on the basis of all facts and circumstances for each individual case.

The subheadings “Examples of Covered Benefits” and “Examples of Non-Covered Benefits” are meant to give specific examples but are not intended to be an all-inclusive list of examples, unless specified in the text of the benefit.

• 2023 Medi-Cal
• 2023 IEHP DualChoice (HMO D-SNP) and Plan Benefits and Cost Sharing

 If a benefit question is not addressed in the Benefit Manual, please contact IEHP at (909) 890-2000 for further information.

The manual documents the procedures, protocols, and formats for electronic data exchange between IEHP and its contracted Providers related to Member eligibility, encounter data, bed-day reporting, capitation reports, and electronic claims submissions.

The following sections document the processing schedules, file formats, procedures, and narrative information that is necessary for Providers to understand and conduct electronic data exchange that is HIPAA compliant which is required under the IEHP Agreement.

For comments, questions about this manual or technical support, contact the IEHP IT Help Desk at (909) 890-2025 or by email at: HELPDESK@iehp.org.